The Painkiller That Saves Money But Costs Lives 385
Hugh Pickens writes "Over 2,000 patients have died since 2003 in Washington State alone by accidentally overdosing on a commonly prescribed narcotic painkiller that costs less than a dollar a dose and the deaths are clustered predominately in places with lower incomes because Washington state has steered people with state-subsidized health care — Medicaid patients, injured workers and state employees — to methadone because the drug is cheap. Methadone belongs to a class of narcotic painkillers, called opioids, that includes OxyContin, fentanyl and morphine. Within that group, methadone accounts for less than 10 percent of the drugs prescribed — but more than half of the deaths and although Methadone works wonders for some patients, relieving chronic pain from throbbing backs to inflamed joints, the drug's unique properties make it unforgiving and sometimes lethal. 'Most painkillers, such as OxyContin, dissipate from the body within hours. Methadone can linger for days, pooling to a toxic reservoir that depresses the respiratory system,' write Michael J. Berens and Ken Armstrong. 'With little warning, patients fall asleep and don't wake up. Doctors call it the silent death.'"
it is harder to get high on (Score:5, Insightful)
because of the way it works, junkies don't prefer it. so who cares if a bunch of people die needlessly, at least it prevents people from getting high. the drug war matters more.
Re:it is harder to get high on (Score:5, Interesting)
Wait: You use it as a painkiller? Why do you do that? It's almost the worst opioid you could possibly use for that!
There is no way that methadone should be used for anything other than treating opioid addiction.
Re:it is harder to get high on (Score:5, Informative)
It's prescribed as a painkiller more often than as a treatment. I'm a pharmacist and I go through methadone like mad and not on the prescriptions I fill is for addicition. I spoke to a pain doctor once who told me it was a cheaper alternative to OxyContin, which can run $600/month without insurance. Methadone runs about $30 a month without.
Some patients with insurance won't take OxyContin because their copay is high.
Re:it is harder to get high on (Score:5, Informative)
It's prescribed as a painkiller more often than as a treatment. I'm a pharmacist and I go through methadone like mad and not on the prescriptions I fill is for addicition.
That's because in order to use methadone to maintain addiction, both the prescriber and the dispensing pharmacy have to be specially licensed. I've never heard of a chain or independent community pharmacy licensed as such. Methadone clinics usually have the prescribers and the dispensary at the same site.
Suboxone and the other buprenorphine-containing compounds have similar restrictions on the prescribers but not on the dispensing pharmacies. That's why you see DEA numbers starting with X on Suboxone scripts . . . it means the prescriber has been specifically licensed to manage opioid dependency.
The Republican Face of Future Medecine... (Score:3, Insightful)
...is more of this. Republicans want to turn Medicaid into a block grant program to states, with eroding value because payments won't keep up with inflation. States, squeezed to do more with less, will continue to do the cheap thing instead of the right thing for the poorest, most vulnerable (those with no cash to buy influence), and the poor will suffer and die in a greater and growing proportion to the rest of us.
They'll do the same thing to Medicare. So keep it up, poor and middle class, keep
Both Major Parties' Face of Future Medicine... (Score:5, Insightful)
Washington State is controlled by Democrats. The majority of both houses of the legislature there are Democrats, as is the current governor and the last two governors before her. I expect, though, that you're too busy hating Republicans to recognize the Democrats are no different.
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Yes but the policy was put in place during a time when the Republicans controlled 100% of the federal legislative line (House, Senate, Congress) and were screwing with the funding that comes from Medicaid/Medicare, forcing states to try to do precisely this.
And it's not just Washington state, this is happening across the nation. Where I live, public medical care (which my grandmother is on) REFUSES to pay for a prescribed non-generic medication if there is a "generic alternative" available, even if her doct
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The hell with all of you. This thing isn't a partisan issue, though historically the Republicans have been the biggest proponents of the War On Drugs (TM), it is completely true that Democrats have not done much of anything to do away with it. Partly that's because anybody who does anything contrary to what police, prosecutors, judges, and the private prison system wants are immediately subjected to a well-financed publicity barrage calling them "soft on crime" (unless, that is, the crime is that of steal
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The only thing Republicans wanted to fund with Medicare is the prescription drug "benefit", which was entirely their idea and which contains a prohibition against negotiating with drug companies for lower prices. Therefore, it's a giveaway of tax money to large corporations--a Republican specialty. However, do you hear Democrats calling them out on it loud and clear? No? Why not? Everyone needs to start asking questions like that.
That's actually really easy to answer: your assumption that corporatism is a Republican specialty doesn't hold water. The Democrats are just as bad.
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Wow, you have a way with history.
Yes. Accuracy.
The subprime lending bubble (2008 recession) was not the brainchild of Democrats, but rather was directly caused by systematic deregulation and removal of banking financial oversight by each Republican administration starting with President Reagan.
Thats what the Democrats told you.
2001: Bush Administration asks congress to look into heavier regulations, stating that they are a "potential problem, financial trouble could cause strong financial repercussions in financial markets"
2003: Bush Administration pushed hard for a new federal agency to regulate and supervise fannie and freddie, stating "We need a strong regulatory agency to oversee the prudential operations of the GSE's, and the safety and soundness of their financial activ
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Alright, Rockcoon, challenge accepted. I am going to show with the facts in this post that you are both stubornly stupid, and unabashedly dishonest.
The Republicans tried to do something about it the whole way while the Democrats prevented anything from being done about it the whole way.
Yeah... that's complete bullshit. Sure... there was the Home Ownership and Equity Protection Act (94), which directed the Federal Reserve to issue regulations of mortgages, but Greenspan refused to use it. Greenspan has ever been against regulation in any form (again... my mind boggles why you mentioned him in a previous post as though it supported your faliciou
Re:Both Major Parties' Face of Future Medicine... (Score:5, Insightful)
If it were Republicans in power, folks on the right would be beating the drum of fiscal responsibility.
As they did during the Bush 43 administration?
Re:it is harder to get high on (Score:5, Interesting)
I disagree entirely. You have to select patients very carefully, but it works wonders on some. I'm a pharmacy resident at a mid-sized hospital, and I did a pain consult on a patient who was sedated and intubated in the ICU. Poor nurse was out of her mind giving him Dilaudid shots every 30 minutes so he wouldn't spike his BP and breathe against the ventilator (both signs of inadequate pain control). Wanted to give him a longer acting opioid for basal pain control. Can't use OxyContin or MSContin here cause you can't crush it to put it in a feeding tube. Guy was also morbidly obese so it would take several days for a Duragesic patch to saturate all the subcutaneous binding sites. Methadone turned out to be the perfect answer.
Obviously you have to be extremely careful, but I don't have a problem with using methadone so long as the patient has good renal function, good hepatic function, good respiratory function (or a protected airway) and isn't taking any drugs that lengthen the QTc interval. This tends to rule out your older, sicker patients, and I suspect that most of the deaths from methadone toxicity happens in them.
In the case specifically addressed in TFA, the fact that the patient was on both methadone and Oxy simultaneously is mind-boggling. Especially in the setting of sleep apnea. More blame rests on the prescriber than on the drug.
Re:it is harder to get high on (Score:5, Insightful)
The problem, I gather, is that the primary selection criterion being used here is "poor'. That's a fairly bad criterion for any medical decision.
The sad part is that there is no good reason for any of the opiates to be terribly expensive. It doesn't help that our government would rather see chronic pain sufferers dead or screaming in agony rather than admit the war on drugs is a failure.
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The problem, I gather, is that the primary selection criterion being used here is "poor'. That's a fairly bad criterion for any medical decision.
The sad part is that there is no good reason for any of the opiates to be terribly expensive. It doesn't help that our government would rather see chronic pain sufferers dead or screaming in agony rather than admit the war on drugs is a failure.
This can't be said often enough. As far as I know, Oxycontin is nothing more than timed-release oxycodone. It must be on a new patent for the particular formulation, because the patent on the base medicine has long since expired. I'm currently dealing with a ruptured disk in my neck and just picked up a refill of generic oxycodone - 30 for $7.90. FWIW, a bottle of 30 cyclobenzaprine (generic form of Flexeril) is $4.00. It's criminal that we allow patents on trivial reformulations of drugs whose original pat
methadone is very useful in managing chronic pain (Score:5, Informative)
Methadone's pharmacokinetics give it a long half-life, and therefore a long duration of action. This is an asset in managing chronic pain from cancer and some other diseases. Methadone has much less tendency to lose its analgesic effect through habituation. Morphine, for example, while an effective pain reliever due to its action on the mu-opioid receptor, has a metabolite that acutally upregulates perception of pain due to action on the NMDA system. This latter effect probably accounts for most of the often-observed dose escalation needed to maintain effective analgesia in patients treated with morphine. The primary danger of methadone is that physicians who are unaware of its comparitively slow pharmacokinetics overdose their patients because they escalate the dose too fast. It is critical to make changes (either increase or decrease) in methadone dosage *slowly* - when that is done, the drug can provide chronic pain relief with a much better combination of safety and long-term effectiveness than many of the other opiates. As always, ignorance seems to be the most deadly disease.
Re:methadone is very useful in managing chronic pa (Score:5, Insightful)
That and patients don't understand methadone kinetics (not too surprising). There is a tendency to 1) take extra doses to help dull the pain (or deal with withdrawal issues) and 2) medicate with something else. Typically the something else is alcohol. The combination of alcohol and methadone is especially dangerous. Two potent respiratory depressants with very different kinetics.
Methadone is the poster child for all that is screwed up with pain control and addiction in this country. As usual, it is popular to shoot the 'messenger'. Until the ability to deal with narcotic addiction is wrestled away from the DEA and until patients in general feel like their problem is more of a medical one than a legal one it's just going to get worse. As an ER doc, I'm seeing methadone in a lot of urine drug screens these days. Talking to patients (the ones that will talk, anyway) they are mostly taking it to deal with withdrawal symptoms when they can't get their drug of choice. Of course, that leads them to manage their problem on their own with a very dangerous drug. Not a terribly safe nor effective combination.
Re:it is harder to get high on (Score:4, Informative)
I do not frequently prescribe methadone (I am a physician) because it's not often I have patients on chronic opioid medicine who I consider responsible enough to use it safely. And, I have seen inexperienced staff at pain specialty clinics nearly kill people a few times. But, if your drug plan won't cover sustained-release oxycodone or morphine (common until a few years ago in the US when morphine SR finally went generic) it's a viable alternative.
For a list of "worst" opioid agonists in terms of effectiveness for pain, consider codeine and propoxyphene (as in Darvocet in the US), both of which don't seem to be more effective than acetaminophen/paracetamol.
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Wait: You use it as a painkiller? Why do you do that? It's almost the worst opioid you could possibly use for that!
There is no way that methadone should be used for anything other than treating opioid addiction.
Incorrect. Probably most medications have multiple uses, and just because something is suited for A doesn't mean it can't also be used for B.
This was a problem for me when moving to the US. Due to spinal injury, I needed a pain control method that was strong enough to affect nerve pain, fast acting enough to be used for acute pain, and would not leave me an addict.
Buprenorphin is used for this in Europe. With pills dissoving under your tongue, it's as near instant relief as you can get without injections
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Why not use diamorphine?
Re:it is harder to get high on (Score:5, Informative)
Why not use diamorphine?
Too short of a duration of action. The purpose of using morphine as a replacement for OxyContin is because it's long acting, providing analgesia throughout the day. Diamorphine has a short, intense onset (which is why it's so addictive) and a similarly rapid cessation.
The current regulatory environment in the US, where diamorphine is Schedule I, may also have something to do with it.
(For those who are less pharmaceutically inclined, diamorphine = heroin.)
Re:it is harder to get high on (Score:5, Funny)
(For those who are less pharmaceutically inclined, diamorphine = heroin.)
(For those who are more C++98 inclined, diamorphine == heroin.)
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Sorry, you are correct.
Re:it is harder to get high on (Score:4, Interesting)
Because the library author already took care of that detail. Put the cursor on diamorphine and press F3 (Eclipse):
const Narcotic diamorphine = C21H23NO5;
The chemical formula isn't specific enough. Different compounds can have the same chemical formula but entirely different structure and are known as isomers.
It gets even more confusing when you have compounds that look the same on first glance but differ due to chirality.
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The naloxone in suboxone does nothing it's there for marketing purposes. You can shoot suboxone just as easily as subutex. Trust me I know.
Who can you mod this fiend up? (Score:3)
There is a "war" on drugs because there are too many inhuman assholes like you in society who cares about nobody but themselves.
This is ridiculous (Score:5, Insightful)
you're an idiot (Score:3, Interesting)
the most potent destroyer of freedom in the entire history of mankind, by orders of magnitude, is no government, it is drug addiction
there is no stronger bars that the most depraved government can build then the bars the drug addiction place in your mind. a constant interrupt switch "get high... get high... get high" makes unable to work, maintain a relationship, think thoughts of philosophy, art, design, anything deep because of the pain of withdrawal
and this is the real story of the history of opium addic
Re:This is ridiculous (Score:5, Insightful)
I'd wager cost has nothing to do with it and that they're being prescribed methadone over Oxycontin because of the reputation Oxycontin has, and the doctors don't want to be associated with Oxycontin.
And it's not that Oxycontin is a 'bad' medication, but it's gotten caught up in our moralistic, war on drugs mindset.
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Well, the point of the article was that it was only Medicaid that was putting people on Methadone after putting it on the 'preferred drugs' list, implying that it is an 'equally safe' drug against all evidence to the contrary.
Meanwhile those with private insurance still get prescribed the more expensive Oxycontin.
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And it's not that Oxycontin is a 'bad' medication, but it's gotten caught up in our moralistic, war on drugs mindset.
And methadone hasn't? I know it isn't what the cool kids are using, but methadone has been on the naughty list for awhile.
BTW, it isn't our moralistic, war on drugs mindset. You can claim it if you wish, I prefer not to.
Re:This is ridiculous (Score:5, Interesting)
I have a problem with chronic kidney stones. My PCP eventually sent me to a pain clinic, where a doctor evaluated my current meds, my current needs, etc. I got a prescription for Oxycontin. Upon trying to fill this prescription, there were only two pharmacies that could fill it (several manufacturers were shut down due to illegal selling/distribution). One was at the pain clinic where I got the script, and the other was at CVS where I always filled all of my other prescriptions. The pharmacist was way way way beyond rude and pretty much called me a junky. I was absolutely furious. This man has made an extreme judgement of who I was because of my need for a powerful painkiller.
I come to find out this particular person owns http://banoxycontin.com/ [banoxycontin.com]. It was obvious this person had an agenda and I was just one of his targets to push it. I can't get anymore into the resolution of the situation, but rest assured I won.
The "war on drugs" causes shit like this. It ends up just being a witch hunt and there are too many innocents that end up burning
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Oxycontin has its reputation for a reason - it's both one of the most effective painkillers available, and one of the most addictive.
I know at least 2 people who became seriously addicted to oxycontin after having been prescribed it. Specifically, my uncle had severe pain due to complications of meningitis, and it was by far the most effective drug for him. Unfortunately, It doesn't take long to build up a psychological and physiological addiction to it. In the end, overcoming this was possibly worse ove
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Yes, and "other opioids" are expensive because they are controlled. Opium used to be cheaper than alcohol until it was controlled.
Having said that, methadone is not intrinsically "more lethal" than other opioids, it is simply more likely to be used incorrectly. But the property that makes it more likely to be used incorrectly (long half life, less addictive) also makes it useful in many situations.
Accidental overdose? (Score:2, Funny)
How can you accidently take more than the prescribed amount?
Can't decipher the doctor handwriting?
Re:Accidental overdose? (Score:5, Informative)
Overdose isn't when you take more then prescribed, it's when you take more then what your body can handle.
As such most overdoses are accidental.
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> Overdose isn't when you take more then prescribed, it's when you take more then what your body can handle.
According to Wikipedia [wikipedia.org], an overdose "describes the ingestion or application of a drug or other substance in quantities greater than are recommended[1] or generally practiced.[2]"
So your use of the word is incorrect.
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> According to Wikipedia [wikipedia.org], an overdose "describes the ingestion or application of a drug or other substance in quantities greater than are recommended[1] or generally practiced.[2]"
So your use of the word is incorrect.
We don't recommend "ingestion or application of a drug or other substance" in quantities greater than what your body can handle, so therefore taking more drug that the body can handle is, in fact, overdose.
Seriously, you're going to bicker over semantics?
I know, I know, I must be new here, etc. etc.
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According to Wikipedia, an overdose...
According to a guy at the bus stop, an overdose...
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Aren't most doses measured by body weight? A 100 lb. woman taking four tylenol would be more affected than a 200 lb. woman. Perhaps a decent medical regulation would be factoring in whatever metrics are needed before dosing.
It would also solve a few problems. I'm a rather large guy (definitely vertically, and a fair bit horizontally). A "normal" dose of Nyquil might make me a wee bit drowsy. A double dose will put me out. If they had weight ranges (or whatever the dosing factor might be), then maybe people
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I am not a doctor, and this is not medical advice.
A proper, correct dose (total amount) of drug is determined by the dosage (amount per body weight) and the weight of the individual. It also should account for individual variations in sensitivity.
Mostly, to save time, doses are determined by multiplying the dosage by an average body weight. For most drugs, which have a very broad dose / response curve, and thus a wide range of therapeutically useful values, that's fine. For some drugs, you have to be mor
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Well, you're describing what you do - but most doctors prescribe whatever the product circular tells them to, and most people take what is prescribed. If you're in a hospital they'll refuse to give it to you most likely if you won't take it as prescribed.
However, in terms of the dosage that is most likely to work for you, the chemistry works more-or-less as you describe. Weight should almost always be a considerating when prescribing medication.
The problem is that many drugs are only available in a few po
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Aren't most doses measured by body weight? A 100 lb. woman taking four tylenol would be more affected than a 200 lb. woman. Perhaps a decent medical regulation would be factoring in whatever metrics are needed before dosing.
Proper dosing of opioids depends on a number of factors. Weight, as you mentioned, is one of them. Depending on exactly what opioid it is, you also have to consider renal function, kidney function, other drugs that might interact, and whether the patient has any genetic differences that may make them respond in a way you wouldn't expect. You also have to consider prior exposure to other opioids, as the patient may have developed cross-tolerance. Then too you have to look at the kind of social support th
Re:Accidental overdose? (Score:4, Insightful)
As far as I know, usually what happens is that while the drug is strong, it's not effective in treating chronic pain because the effectiveness is erratic.
The patient will then take more of the drug, because they think that their dose is too low since it's not being effective, thus ending up overdosing themselves.
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I think the doctor should find a better drug. Is there a cheap drug where the effective dose is not as close to the fatal dose?
Bring on the doctor blame.... (Score:5, Insightful)
Doctors are overpaid
Can we please stop this shit? Blaming doctors doesn't help you, and they are generally not overpaid. For the length and stress of their training, the debt they incur, and the difficult lifestyle many specialties must endure permanently, most doctors are actually underpaid - in overall salary, in compensation per hour, or both.
I know primary care physicians who've been forced quit the business after 30 years and had to go work somewhere else. How does a doctor who can't afford to be a doctor, and doesn't have enough savings to retire after 30 years, fit with your ignorant screed that doctors are overpaid?
I also know surgeons, many of whom do make $300,000 a year, and I've never seen one of them sit still for more than 15 minutes, to watch a movie or lecture, without passing out. They work a minimum of 60 hours a week and constantly get paged for surgery in the middle of the night, whether or not they're actually 'on call'.
So many types of doctor make so little that people are quitting left and right, while med students refuse to even consider the specialty, and many other types work so many hours with such a poor quality of life that their compensation per hour (not to mention per 3 am emergency call) makes engineering and business look like much better careers.
Many doctors are underpaid; many others are overpaid but massively overworked and overstressed. The cross-section of doctors who are both overpaid and live comfortable lifestyles is much, much smaller than you think.
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Easily. How can you accidentally do anything?
Re:Accidental overdose? (Score:5, Interesting)
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[citation needed]
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You said the kid died. Nobody died.
Re:Accidental overdose? (Score:4, Insightful)
How can you accidently take more than the prescribed amount?
Can't decipher the doctor handwriting?
Forget you've taken it and take it again. Anyone can become distracted but the very old (prone to memory related illnesses) and very young (in the care of others) are particularly susceptible.
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Re:Accidental overdose? (Score:5, Insightful)
You've never been in serious pain then.
Even a perfect health 20 year old in a scale of 1 to 10, a 10 in pain will not only forget they took a painkiller, but will want the pain to subside so badly that taking another one is certainly a thought process they go through.
Stick a railroad spike in your head and then pour salt and lime juice on it. Then tell me you will sit there and remember you took a pain pill 30 minutes ago.
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Yep. Been there, done that. You can keep the fucking t-shirt. I won't go into details about what, but when ER doctors challenge my rating the pain at a 6-7 and being able to coherently hold a conversation, I tell them what I experienced at the age of 10 and they turn green at the gills and quite simply prescribe the pain killer to cut the pain while I'm in there without further debate.
When you're in that much pain, you more often than not can't think coherently and you just want the pain to STOP.
Re:Accidental overdose? (Score:5, Insightful)
From the article, it sounds like this is not a problem caused by cheap drugs but by piss-poor medical care. If a patient is given a specific form of Opioid which is known for stuff such as 'With little warning, patients fall asleep and don't wake up", and it does so frequently that they even gave this form of death the pet nickname, "silent death", then it does look like the only problem is that patients aren't monitored accordingly. To put it in other words, it does sound like they are putting the blame on a drug for a problem which is caused by incompetent medical staff which are routinely slacking off monitoring their patients and doing their rounds. Giving poor people sub-standard health care to the point of being considered neglect is a much more serious problem than providing cheap drugs.
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Huh? This is about pain medication that you're prescribed, not the pain medication you get while at the hospital (which tends to be mostly injected Morphine afaik).
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In the case of Methadone, you can HAVE an accidental overdose. It lingers in your system and can leave the normally prescribed dose that would otherwise be safe to be a lethal amount.
Possible FRAUD Alert (Score:5, Informative)
To me, that article and all the data to which the Slashdot story linked screamed incompetence or fraud. Now that I've read a little of the linked data, I realize the writers are at least partly incompetent. Possibly only whoever started them looking was engaged in fraud to sell more expensive drugs.
I just discovered that I'm not the only one who thinks that. [nwsource.com] Short quotes, read the full comments:
"It does not matter if you switch every body to oxycontin or oxycodone. These drugs are terrible at controlling pain and all are very dangerous."
"... I have an issue with how the Seattle Times is drawing a correlation between poverty and methadone poisoning.
Possibly Methadone is more often given to people who have little education, and who are therefore more likely to overdose because they didn't understand the instructions, or because they have other issues that confuse them.
Do you have poor reading comprehension? (Score:3)
Re:Do you have poor reading comprehension? (Score:5, Informative)
Maybe not on your planet, but here on earth, educated people have a much better chance of making money, and people with money are likely to get a better education. People with poor reading skills, or other problems with communication are likely to be on very low incomes all their lives.
I acknowledge that educated people can be poor whether short or long term, but they are not the same boat at all.
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I just bought a 50-pack of Ibuprofen 600 for 5€ (the same price that every drug costs) and a 30-pack of Omeprazol for 0€ (unless it's free ;), thanks to my health insurance which is paid by a tax going off of my salary.
And if I lose my job, there is a government agency that pays for it no matter how long I'm without a job. (Yes, they push you into getting a job and send you job offers. But there is nothing wrong with that.)
I can go to the doctor or hospital as often as I want and I get what's nece
Is it cost, or painkiller paranoia? (Score:5, Interesting)
Doctors don't generally like to prescribe pain killers. They worry about addiction, they worry about the DEA auditing their prescribing habits and yanking their license, without which it's kind of hard to be a doctor.
When they prescribe methadone, is it really out of cost, or have they grown so fearful of prescribing Oxycontin that somehow methadone seems like a reasonable alternative? And how many of those fears are medical/pharmacological, and how many are "if I prescribe Oxycontin I'll get in trouble" or "gee, there's a lot of press about Oxycontin, I shouldn't prescribe it"?
Re:Is it cost, or painkiller paranoia? (Score:5, Interesting)
You raise a good point. I see a pain specialist because of tendon and back problems. Regular doctors are regularly audited, but pain specialists are super audited, and the DEA puts so much pressure on them, that they do NOT like to prescribe pain killers at all if they can help it. (Based on input from 3 different doctors here). They have to keep records beyond the norm, prove that other methods were tried first, etc. I had not had a physical last year, and he wouldn't re-up my prescription until I did. His reasons weren't my health, he flatly said that he could get in trouble. So now our national health policy is party "ruled" by the DEA, a bunch of fucking idiots with a faulty agenda and no real world experience in front line medicine....great.
Re:Is it cost, or painkiller paranoia? (Score:4, Insightful)
Worse than that, I don't even think the DEA applies medical logic -- I think their logic is all about drug control. They could care less about whether clinically effective medicine is taking place, they just want fewer painkillers in civilian hands.
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Apparently, my mileage varies greatly from others. I had a UTI, and they gave me a narcotic. No questions asked, just "here's a week's supply". And since I had 100% coverage, I didn't even give them any cash. It felt weird getting narcotics for just a signature, but there you go.
Later on, during recovery from some major surgery, I had my Oxycotin prescription renewed without question, or hassle for about 2 months (at one point, they later switched me to Vicodin, same stuff, just a higher Tylenol to narcotic
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But then as noted, all of it was short-term, and none of it chronic. Likewise, all of them were well justified pain prescriptions.
That's the key.
My mother-in-law has severe scoliosis and has been in terrible pain for almost 20 years. She also gets lots of narcotics, but both she and her doctor have to jump through a lot of hoops. I had my appendix removed last year and they gave me a prescription without blinking. It actually makes perfect sense, if you buy the whole War on Drugs theory.
Re:Is it cost, or painkiller paranoia? (Score:4, Informative)
From the other perspective, my brother is an ER doctor. He sees many drug-seekers every week. They'll come in claiming specious injuries (my neck hurts) and demand Oxycontin. Last week, some guy claimed that he never had Oxycontin before but needed it. A quick check revealed he had eight prescriptions already. And it's not just anecdotal evidence. Countering drug seeking behavior is one of the more important lessons ER doctors have to learn.
What is anecdotal is my brother's disdain for pain management doctors. He calls most of them quacks who are legalized drug pushers. That's not to trivialize your experience or to denigrate your doctor, but apparently many of these dudes are making money pushing Oxycontin.
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There's a theory that some chronic back pain is due to low-virulent bacterial infection, and you can cure it with a course of the right antibiotics: http://bjsm.bmj.com/content/42/12/969.full [bmj.com]
I won't be surprised if that's true. Periodontal bacteria has been linked to heart disease, and antibacterial mouthwash reduces the risk of preterm deliveries ( http://www.thehealthage.com/2011/02/anti-bacterial-mouthwash-reduces-risk-of-preterm-deliveries/ [thehealthage.com] ).
It took a while for people to find out and prove that helico
Re:Is it cost, or painkiller paranoia? (Score:4, Interesting)
When they prescribe methadone, is it really out of cost, or have they grown so fearful of prescribing Oxycontin that somehow methadone seems like a reasonable alternative? And how many of those fears are medical/pharmacological, and how many are "if I prescribe Oxycontin I'll get in trouble" or "gee, there's a lot of press about Oxycontin, I shouldn't prescribe it"?
Well, let me just tell you: I am not an "addictive personality" and have never had any problems whatsoever like that; I was on Oxy for 1 week after shoulder surgery, and wow; I actually went through (mild) withdrawal--headaches, night sweats, chills... Of course for me there was no temptation to get more to ease those symptoms, instead my reaction was "wow, I sure wouldn't want to take this shit any longer".
And oh yeah, I did feel really good on it, no question about that...
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I had the same reaction to Vicodin. Only took it for a couple of days, and I REALLY wanted more when I stopped. Very scary. A fun couple of days though.
No problem, with the Vicodin. Only the Oxy. Yes, they had me on both ;-) Quit the Oxy first, was on the Vicodin for 2 or 3 weeks...
Also, it's possible I'm remembering it backwards as to which one gave me the withdrawal...
But I remember thinking in my happy fog "it still hurts a little, geez what would it be like without the pills!"
Re: (Score:2)
I took Percocet 24 hours a day for two weeks (roughly equivalent to daily 20 mg Oxycontin tablets) as a result of a bad infection in a wisdom tooth and the subsequent extraction (it's far rougher when you're in your 40s).
I couldn't wait to be off of it -- there was little euphoria as the initial infection's pain was the WORST I had ever experienced, and there was a lot of pain after the extraction (which due to scheduling problems took 4-5 days after the infection).
But after a while, I was just tired and le
Are these all really "accidents" . . . ? (Score:3, Insightful)
. . . faced with a life full of incurable, chronic, unbearable pain . . . this "silent death" might seem like a more pleasant option for some folks.
It would seem like an alternative for a doctor forbidden by law from assisting a patient requesting euthanasia. The doctor prescribes the medication and describes the risks. It is the patient's choice to take a lethal amount.
I live with pain (Score:5, Interesting)
18 years ago I messed up my back, 8 years ago I did it again. The second time around didnt have the results of the first. I live with constant pain while awake unless laying down.
Pain is depressing, it ruins your attitude and life. I have learned to live with it, with pain pills to manage the pain. When sent to pain management every so often to get the pain medication adjusted methadone is always pushed, I am also low income. I have done a lot of study of pain drugs and will always tell the doctor that is one medication I want to avoid. At present I am on Percoset (oxycodone/acetaminophen). While it isnt as cheap as the methadone on my crappy insurance, my life is way more important than the $10 a month extra it costs me.
But the problem may not be the drug itself but the idea that some people in pain have that they can avoid pain completely. This isnt always the case when you are on these types of medication. You can control pain, you can moderate pain. But if you think that if I take a pill or two extra it will get rid of it altogether you are on a slippery slope. My brother tried that, he ended up taking more and more pills because over time your body starts resisting them. Thats where the danger lies. You take so many that you end up killing yourself by overdose, like my brother did at 36.
Re:I live with pain (Score:5, Interesting)
You just illustrate the problem with the war on drugs. You're taking acetaminophen. The only reason it is in the pills is to kill you if you dare to take too much. They could either prescribe the oxycodone on its own or in combination with a safer NSAID and it would only be safer and more effective.
Too many painkillers are designed with a LACK of safety being a design criterion - all because we'd rather kill people who get the dosing wrong rather than risk somebody getting high.
Heroin substitute. (Score:2)
The glaringly obvious solution of the State control and supply of heroin to addicts is apparently beyond those who make such decisions. Far better to throw money up the wall buying a substitute and then pretend you're handing out medicine.
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Here in the UK Methadone has been used as a heroin substitute for some years. It's considered to be more addictive than heroin but of predictable quality and supply, hence its use.
The glaringly obvious solution of the State control and supply of heroin to addicts is apparently beyond those who make such decisions. Far better to throw money up the wall buying a substitute and then pretend you're handing out medicine.
yeah and the side effects of methadone are supposed to be unpleasant enough to deter addiction. Well thats what the Nazis figured when they invented the stuff...
Re:Heroin substitute. (Score:5, Interesting)
We have tons of rules regarding where methadone clinics can go, how many people they can serve, under what conditions people can use it, how long, etc. So you end up seeing a lot of methadone prescribed for "chronic pain", despite the fact that it really kinda sucks for the whole "pain management" thing that opiates normally excel at.
Really, it does one and only thing well - It keeps people from going into withdrawal.
So basically, when you see a cluster of poor minorities with loq education OD'ing on this stuff, it doesn't mean their doctors have failed, it means a not-quite-ex-addict tried to get high on it and learned the hard way that it doesn't work very well for that, either.
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>Here in the UK Methadone has been used as a heroin substitute for some years. It's considered to be more addictive than heroin but of predictable quality and supply
Actually I don't think that's the issue - the predictable quality and supply - that's only an issue with illegal drugs - because of the dealers cutting them and drug prohibition endangering supply. If you gave the patient medical grade heroin or another opioid - they would also have predictable quality and supply.
I think the real reason they
We have money for bombs, but not people. (Score:5, Interesting)
figures why the world is STILL deep in shit in godfrigging 21st century.
yeah (Score:3)
if you are living IN a society, you have obligations. if you want to live with the exquisitely complex and intricate philosophy of 'me me me, my my my, self self self, myself', then go live on a mountain top.
what provided you with the living standards that separates you from the caveman living in a cave, has been the society. and NO -
Methadone does more than save money (Score:2)
With a skilled doctor and a well-instructed patient, Methadone is a perfectly legitimate and normal Opioid pain reliever. The longer effects of the drug (vs. other options) mean the level in the bloodstream stays more level. Yes, if the patient cannot follow instructions, or the doctor is not aware of how Methadone is metabolized in the body, this can be harmful; there are tradeoffs with almost any drug. You can hardly blame the drug if the doctor ignores the prescribing information or the patient doesn'
You deserve what you get... (Score:5, Insightful)
First, doctors hate the most expensive parts of medicine even more than you do; they'd be ecstatic to see that business go away. Patients incur as much as half of their lifetime medical costs in the last six months or year of their life. Doctors who know it's simply time for someone to die are forced to keep them alive for a few last weeks or months by whining families who can't accept death and by stupid laws that require extreme intervention to the very end. Many people won't sign DNR orders until they've already hung on far too long, if ever; the families rarely sign them for someone too far gone to sign themselves. It's gotten so bad there's even a phenomenon called the Silent Code, when the physician running an emergency resuscitation tacitly lets a terminal and hopeless patient slip away; they walk the line between honoring laws / families' wishes and the Hippocratic duty to do no harm by not prolonging suffering. Most doctors wish that palliative care and letting people go at their time could be official; a significant minority favor outright assisted suicide. Those brave enough to take some action now do things like silent codes. How does risking your license and reducing your billable hours by letting a patient die display the kind of greedy, insensitive behavior you people seem to think almost all doctors display?
And as for the money, doctors as a whole are not overpaid; doctors may average almost $200,000 a year, and the existence of specialist surgeons who make $700,000 a year makes it easy to assume they're all overpaid, but a complete statistical look at doctor's salaries - one that includes median, mode, and spread indicators- will tell you that the typical salary is pretty fair for a field that involves a minimum of 11 years higher education (often stretching past 15), $150,000+ in educational debt, and usually takes a lot more than 40 hours a week.
So some doctors are overpaid, and some doctors are callous. Show me a profession with neither of those problems. The majority of doctors are paid no more than a fair wage (or even not enough), care deeply about their patients, hate the waste and legal bullshit of medicine much more than you do, and are really tired of taking shit from people who think they like the system this way or got into medicine for the money.
The longer you assholes complain about doctors being stupid or only caring about money, the more stupid pricks who only care about the money will be the only ones willing to go to medical school. That's already starting, in my opinion. Enjoy reaping what you've sown.
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Mod up.
A coworker once relayed how her husband, working hospital IT, was regularly frustrated by doctors (specifically some surgeons) kept having to ask stuff about their computers, and how is it very smart and intelligent people making over $100,000 couldn't figure out such simple concepts?
She probably thought that as a computer geek myself I'd be completely sympathetic to this. She was floored when I said I'd complain about these surgeons not getting technology, if IT people were able to perform an append
I don't buy it (Score:5, Informative)
In terms of pharmacodynamics, methadone is a garden variety opiate. It has two major distinctions: it has good oral bioavailability, and it is long-acting (i.e. it has slow pharmacokinetics). These are major advantages for people with chronic pain. Morphine has poor oral activity, and also wears off fast. This makes it good for intravenous infusion in a hospital setting, but terrible for patients with severe chronic pain. One aspect of opiate analgesia is that once the pain "breaks through," it is hard to knock it down again. Opiates work best for pain relief if blood levels are kept reasonably constant. So with a short acting opiate, patients have to be constantly popping pills. A long-acting opiate makes it possible for a patient with chronic pain to live something approaching a normal life.
Respiratory depression by opiates tracks very well with pain relief, so it is not plausible that the respiratory depression would greatly outlast the pain relief, as claimed in the article. Moreover, we have a huge amount of experience with methadone, because it is widely used for opiate maintenance in opiate addicts. Opiate addicts take methadone under supervision, so they can't escalate their doses. So we know that when methadone is taken as prescribed on a regular basis, it is safe and effective, and toxic levels do not build up in the body.
I think that this is a problem of poor patient and physician education and poor choices by physicians in prescribing a long-acting drug to patients who don't really understand what that means. The average patient has no experience with long-acting pain relievers, because all of the commonly used medications such as hydrocodone are short-acting. The pain relief of a long-acting opiate lasts a long time, but it is also slow in onset. This is an unavoidable aspect of the pharmacokinetics of long-acting drugs. That means that you can't wait until you start hurting, then take a methadone pill and expect the pain to go away in under an hour, as with short-acting drugs. It will take days for the pain relief from methadone to build up to its full level. A patient who doesn't understand this is likely to think, "It isn't working," and take more than the prescribed dose--and then when it does build up, they end up in respiratory depression.
There is no way to have a long acting opiate pain killer drug that does not carry the same risk as methadone. The same hazards apply to oxycontin (which is a time-release formulation of a short-acting opiate, oxycodone).
So the patient needs to be told in no uncertain terms, "This isn't a drug where you can wait until you start hurting and then take a pill. It won't work, and it is dangerous to take it that way. You must take it on schedule, every day. You can't take extra even if you are hurting. If you miss a pill, don't take extra to make up. If you take more than the prescribed dose, or take it more often than prescribed, you may DIE." And the doctor needs to be absolutely certain that the patient understands this and is capable of complying. If not (or if there is not a reliable care-giver capable of controlling dosing), then the patient should be prescribed a short-acting narcotic (although this carries its own, different risks).
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So the patient needs to be told in no uncertain terms, "This isn't a drug where you can wait until you start hurting and then take a pill. It won't work, and it is dangerous to take it that way. You must take it on schedule, every day. You can't take extra even if you are hurting. If you miss a pill, don't take extra to make up. If you take more than the prescribed dose, or take it more often than prescribed, you may DIE." And the doctor needs to be absolutely certain that the patient understands this and is capable of complying. If not (or if there is not a reliable care-giver capable of controlling dosing), then the patient should be prescribed a short-acting narcotic (although this carries its own, different risks).
That information was not given to me when I was prescribed Vicodin while passing kidney stones. So, I learned the hard way that if I waited for the pain to start before taking another dose rather than taking it on schedule, I'd be miserable for a half hour before the new dose took effect. In hindsight, I can see how somebody could accidentally overdose in that situation, if they didn't understand that they just need to wait for the pill to take effect or if the pain was bad enough to drive them to desperati
Re:Cynicism (Score:5, Informative)
No perchance, and it was idiotic to even say, since you have easily looked it up and see that its protection was basically stripped from a defeated Germany in 1947. Wikipedia is your friend, laziness is not.
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I heard that the Nazis developed methadone because they wanted a pain killer that wouldn't be as addictive as other opiates.
They figured that if they made the side effects sufficiently horrible, people wouldn't get addicted to it.
How wrong they were...
Re: (Score:2)
IIRC Heroin was developed as a less addictive substitute for morphine. The history of opioid development is amusing in a macabre fashion.
Re:It even has its own tribute band (Score:4, Insightful)
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I think that has to do more with its use as a heroin replacement for addicts than its use as a painkiller...
Re:Well, pain killer, lol (Score:4, Insightful)
Basically instead of letting junkies do crimes to get their hand at illegal drugs, let's doctors prescribe it, with the official "goal" of getting the junkie some time in the far future clean).
And it works! If you give a junkie a reliable, free supply of opiates, they quit the cycle of binging then stealing things when they run out, are generally able to function in society, and gradually wean themselves off. It is more effective than any other treatment.
Methadone is particularly effective because for this because it's very long-acting. It doesn't provide a reward rush when you take it, and it doesn't crash fast leaving them desperately craving.
they are forced to go in daily to the pharmacy and consume it on site.
Sure. Heroin users are used to gauging their dose by the immediate response. Methadone is really slow, so they think they didn't take enough and take more, only to end up overdosing when it hits. For non-addiction prescriptions they just give you a 30-day supply.
And using heavy addiction inducing drugs as a general pain killer medication is not sound policy
What would you suggest for severe pain? Advil isn't going to do it.